Global, regional, and national epidemiology of leukemia in children from 1990 to 2021: A cross-sectional study

Childhood leukemia remains a critical global public health challenge, contributing significantly to disability and premature mortality. Despite progress in healthcare, comprehensive estimates of its burden across geographic and sociodemographic strata remain essential for formulating evidence-based interventions. Utilizing data from the Global Burden of Diseases 2021, this cross-sectional study analyzed leukemia incidence, deaths, and disability-adjusted life years (DALYs) among children aged 0 to 14 across 204 countries and territories from 1990 to 2021. Stratified analyses by region, nation, age, sex, leukemia type, and Sociodemographic Index (SDI) were conducted, with estimated annual percentage changes calculated to assess trends. In 2021, childhood leukemia caused 58,785 incident cases (95% uncertainty interval [UI], 43,200–73,139), 27,861 deaths, and 2,341,610 DALYs globally, corresponding to an incidence rate of 4.37 per 100,000 (95% UI, 3.51–5.46). From 1990 to 2021, global incidence and death rates declined by a total of 0.23% (95% UI, −0.44% to −0.11%) and 0.52% (95% UI, −0.64% to −0.35%), respectively. However, the low-SDI region exhibited rising incidence, mortality, and DALY rates. Australasia experienced the largest incidence increase (estimated annual percentage change: 0.67%, 95% confidence interval, 0.23%–1.11%). Nationally, San Marino reported the highest incidence (13.79 per 100,000; 95% UI, 8.03–21.07), while Tokelau had the highest mortality (7.92 per 100,000; 95% UI, 4.36–13.32) and DALY rates (116.39 per 100,000; 95% UI, 86.46–139.97). Despite global reductions in childhood leukemia burden over 3 decades, persistent disparities across SDI subgroups and regions underscore unmet needs in low-resource settings. Precision epidemiology and context-specific strategies are imperative to mitigate inequities and optimize prevention and care.